Toxic multinodular goiter physical examination

Toxic multinodular goiter Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Toxic multinodular goiter from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Toxic multinodular goiter physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Toxic multinodular goiter physical examination All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Toxic multinodular goiter physical examination
CDC on Toxic multinodular goiter physical examination
Toxic multinodular goiter physical examination in the news
Blogs on Toxic multinodular goiter physical examination
Directions to Hospitals Treating Toxic multinodular goiter
Risk calculators and risk factors for Toxic multinodular goiter physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

The clinical features of toxic multinodular hyperthyroidism includes flushing,diaphoresis, smooth skin, onycholysis, hyperpigmentation, thinning of the hair, thyromegaly,[lymphadenopathy]], lid lag, shortness of breath on exertion, hypoxemia, hypercapnia, tachycardia, atrial fibrillation, weight loss, increased appetite anorexia, dysphagia, increased urinary frequency, enuresis, gynecomastia, reduced libido, erectile dysfunction, psychosis, agitation, and depression,anxiety, restlessness, irritability, and emotional lability, insomnia, confusion, poor orientation and immediate recall, amnesia, and constructional difficulties, peripheral neuropathy, carpal tunnel syndrome, tremors, myopathy, muscle weakness, proximal and distal weakness, deep tendon reflexes are usually normal or increased, osteoporosis and an increased fracture

Physical Examination

Appearance of the Patient

• Patients with thyroid adenoma are usually well-appearing.

Skin

• Flushing
• Diaphoresis
• Smooth skin
• Onycholysis and nail softening
• Hyperpigmentation
• Thinning of the hair

Neck

• Thyromegaly with solitary, non-tender thyroid nodules.
• Soft, smooth, and mobile nodules.
• Lymphadenopathy

HEENT

• Lid lag occurs in all patients with hyperthyroidism due to sympathetic overactivity.

Lungs

• Shortness of breath on exertion
• Hypoxemia
• Hypercapnia
• Tracheal compression from a large goiter.
• Pulmonary hypertension.

Heart

• Tachycardia with wide pulse pressure.
• Systolic hypertension
• Congestive heart failure
• Dilated cardiomyopathy
• Atrial fibrillation

Abdomen

• Weight loss
• Increased appetite
• Anorexia in older hyperthyroid patients.
• Dysphagia
• Cholestiatosis

Genitourinary

• Increased urinary frequency and nocturia
• Enuresis is common in children.
• Gynecomastia
• Reduced libido
• Erectile dysfunction.

Neuromuscular

• Psychosis, agitation, and depression.
• Anxiety, restlessness, irritability, and emotional lability.
• Insomnia
• Cognitive impairments such as confusion, poor orientation and immediate recall, amnesia, and constructional difficulties.
• Peripheral neuropathy
• Carpal tunnel syndrome

Extremities

• Tremor-high frequency and low amplitude and can involve the face and head as well as the extremities.
• Myopathy 
• Muscle weakness with or without atrophy and myalgias.
• Proximal and distal weakness.
• Deep tendon reflexes are usually normal or increased,
• Paresthesias, due to coexisting polyneuropathy

Bone

• Osteoporosis and an increased fracture